Combination therapy: ICI + TKI

ICI: Immune Checkpoint Inhibition
TKI: Tyrosine Kinase Inhibition
AE: adverse event

Note: This is not a diagnosis/management tool for patients. Patients should always consult their treating specialist.

General principles

Types of AEs:

  • most frequent overlapping AEs: fatigue, diarrhea, hepatotoxicity, endocrine toxicity and skin reactions
  • see image below: overview of typical AEs with TKI and ICI, adapted from McGregor et al 2021 Cancer Treatment Reviews

Timing of AE:

  • TKI: usually early (< weeks) after treatment initiation and quick to regress following dose hold
  • ICI: unpredictable, can be months after treatment discontinuation

Management principles:

  • according to CTCAE v5.0 grade and probable culprit
grade 1 mild: a- to paucisymptomatic no intervention required
grade 2 moderate: minimal symptoms local/non-invasive treatment
grade 3 severe: important symptoms, hospitalisation required medical treatment
grade 4 life threatening urgent intervention
  • treatment options:
AE possibly related to both ICI and TKIAE considered related to TKI